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  <head>
    <title>053-02 Menstrual mechanisms, pelvic emergencies, reproductive planning, and contraceptive safety</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Menstrual mechanisms, emergencies, and contraceptive safety">
      <outline text="First questions and early pregnancy">
        <outline text="Pregnant, unstable, or losing blood supply?"/>
        <outline text="Pregnancy test whenever biologically possible">
          <outline text="Ectopic and miscarriage mimic other conditions"/>
        </outline>
        <outline text="Privacy, consent, trauma-informed explanation"/>
        <outline text="Pregnancy of unknown location, not simply too early">
          <outline text="Integrate haemodynamics, ultrasound, gonadotropin trend"/>
          <outline text="No single value proves normal or abnormal"/>
        </outline>
        <outline text="Shoulder-tip pain, syncope, peritonism suggest rupture"/>
        <outline text="Management safety depends on assured follow-up"/>
      </outline>
      <outline text="Menstrual cycle mechanism">
        <outline text="Falling steroids release gonadotropin drive">
          <outline text="Follicle-stimulating hormone recruits follicles"/>
        </outline>
        <outline text="Dominant follicle raises oestradiol and inhibin">
          <outline text="Negative switches to positive feedback">
            <outline text="Luteinising-hormone surge"/>
          </outline>
        </outline>
        <outline text="Luteal progesterone stabilises secretory endometrium"/>
        <outline text="No implantation: luteal regression">
          <outline text="Spiral arterioles constrict, mediators activate">
            <outline text="Functional layer sheds"/>
          </outline>
        </outline>
      </outline>
      <outline text="Bleeding history and mechanisms">
        <outline text="Quantify rather than label heavy or irregular"/>
        <outline text="Intermenstrual, postcoital, postmenopausal differ"/>
        <outline text="Normal haemoglobin does not exclude iron depletion"/>
        <outline text="Structural: polyps, fibroids, adenomyosis, neoplasia"/>
        <outline text="Non-structural: coagulopathy, ovulatory, drugs"/>
        <outline text="Anovulation prolongs unopposed oestrogen">
          <outline text="Unstable endometrium sheds irregularly"/>
        </outline>
      </outline>
      <outline text="Acute bleeding and endometrial sampling">
        <outline text="Treat by circulation and ongoing loss"/>
        <outline text="Tranexamic acid reduces fibrinolysis"/>
        <outline text="Hormones stabilise endometrium when appropriate">
          <outline text="Avoid oestrogen with thrombotic or vascular risk"/>
        </outline>
        <outline text="Once stable, find cause and restore iron"/>
        <outline text="Sample by cancer probability, not thickness alone"/>
        <outline text="Postmenopausal bleeding always assessed"/>
        <outline text="Hysteroscopy finds focal lesions blind biopsy misses"/>
      </outline>
      <outline text="Torsion and ruptured cyst">
        <outline text="Unilateral pain with nausea raises torsion"/>
        <outline text="Twisted pedicle blocks venous before arterial flow">
          <outline text="Oedema then infarction"/>
        </outline>
        <outline text="Doppler flow can persist">
          <outline text="Dual blood supply or intermittent torsion"/>
        </outline>
        <outline text="Urgent laparoscopy detorses and preserves ovary"/>
        <outline text="Ruptured haemorrhagic cyst bleeds intraperitoneally"/>
      </outline>
      <outline text="Pelvic inflammatory disease">
        <outline text="Low threshold clinical diagnosis">
          <outline text="Prevents tubal injury"/>
        </outline>
        <outline text="Fever and raised markers may be absent"/>
        <outline text="Negative nucleic-acid tests do not exclude it"/>
        <outline text="Treatment reduces infertility, ectopic, abscess"/>
      </outline>
      <outline text="Endometriosis">
        <outline text="Inflammatory, fibrotic disease outside the cavity"/>
        <outline text="Pain reflects location, nerves, sensitisation">
          <outline text="More than visible lesion volume"/>
        </outline>
        <outline text="Normal ultrasound misses superficial disease"/>
        <outline text="Empirical hormonal suppression if no warning features"/>
        <outline text="Laparoscopy if uncertain, fertility, or resistant"/>
      </outline>
      <outline text="Amenorrhoea and polycystic ovarian syndrome">
        <outline text="High gonadotropins, low oestradiol: ovarian insufficiency"/>
        <outline text="Low or normal gonadotropins: central suppression"/>
        <outline text="Prolactin inhibits gonadotropin-releasing hormone"/>
        <outline text="Functional hypothalamic amenorrhoea: low energy">
          <outline text="Low oestradiol harms bone, heart, fertility"/>
          <outline text="Pill bleeds do not correct energy deficit"/>
        </outline>
        <outline text="Polycystic ovarian syndrome after exclusions">
          <outline text="Rapid virilisation demands urgent investigation"/>
          <outline text="Progestogen reduces endometrial hyperplasia"/>
        </outline>
      </outline>
      <outline text="Infertility and contraception">
        <outline text="Infertility is a couple assessment">
          <outline text="Reserve tests are not an egg-quality score"/>
        </outline>
        <outline text="Separate perfect-use from typical-use failure"/>
        <outline text="Condoms reduce infection transmission"/>
        <outline text="Avoid unnecessary examinations delaying initiation"/>
        <outline text="Leg swelling, chest pain, headache: urgent review"/>
        <outline text="Combined methods raise venous and arterial thrombosis"/>
        <outline text="Enzyme inducers weaken hormonal, not intrauterine"/>
        <outline text="Emergency contraception acts before implantation"/>
      </outline>
      <outline text="Menopause and warning signs">
        <outline text="Follicular depletion causes menopause"/>
        <outline text="Unopposed oestrogen causes endometrial hyperplasia"/>
        <outline text="Local vaginal oestrogen: low systemic exposure"/>
        <outline text="Persistent warning symptoms need examination"/>
        <outline text="Screening is not a diagnostic test for symptoms"/>
        <outline text="Vulval symptoms need direct skin inspection">
          <outline text="Presumed candidiasis can delay diagnosis"/>
        </outline>
      </outline>
    </outline>
  </body>
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